Medicaid Modernization Quarterly Report Demonstrates Unprecedented Transparency

March 15, 2017

Today, Gov. Terry Branstad and Lt. Gov. Kim Reynolds commend the Iowa Department of Human Services (DHS) for releasing the third Medicaid Modernization Quarterly Report demonstrating improved patient outcomes, strong consumer protections, and robust program integrity in the first nine months of Medicaid Modernization. Gov. Branstad signed every Medicaid Modernization oversight item into law from the 2015 and 2016 legislative sessions.  Medicaid Modernization is delivering more accountability in our Medicaid program than ever before by tracking nearly 1,000 measurable performance and health outcomes.


“We modernized our Medicaid Program on April 1, 2016, to improve patient health outcomes. This new Medicaid Modernization Quarterly Report demonstrates Iowa patients and Iowa taxpayers have the most thorough and transparent look and review of our Medicaid program.  These reports help us improve Medicaid patient health,” Branstad said. “Since April 1, over 238,000 patient health risk assessments and outreach efforts were conducted identifying risk factors to a patient’s health helping them live longer, healthier lives.”


Lt. Gov. Reynolds added, “A goal of Medicaid Modernization is to provide effective care coordination and preventative services. More than 29,000 adults and children with high-risk behavioral health conditions, now have a health care coordinator assigned to them integrating their care. These efforts are improving care for our most vulnerable Iowans. In addition, more than 67,000 value added-services, such as wellness programs and tobacco cessation, have been utilized in the past six months improving the health and well-being of Medicaid patients.”


Medicaid Modernization is a proactive, patient-centered approach to modernizing Iowa’s old Medicaid program. Patients have more choice than ever before fitting their individual needs, more access to services, and real accountability improving the health of more than 500,000 Iowans. Medicaid Modernization has delivered unprecedented transparency and results into Medicaid.  Managed care is working for Iowa taxpayers by stopping improper payments. Iowa’s old Medicaid fee-for-service program had an improper payment rate in 2014 of 9.9%, accounting for $318,590,017 in improper payments.




Medicaid Modernization October – December 2016 Quarterly Report Executive Summary


The third Medicaid Modernization Quarterly Report is a comprehensive review of key metrics focused on outcome achievement, consumer protection, and program integrity.


  • Health Risk Assessments:  Over 238,000 patient health risk assessments and outreach efforts were conducted in the first nine months of Medicaid Modernization by the health plans.  Health risk assessments were not required in the old Medicaid program.  Patients identifying risk factors to their health and making corrections help them live longer, healthier lives. 


  • More Patients in Home and Community Settings: Many of our long-term services and supports population prefer to be in a home and community-based setting rather than an institutional setting. Since Medicaid Modernization began, 3% more patients are in home and community-based settings.


  • Health Plans Exceed Paid Claims Requirements:  For the third quarter in a row, all three health plans exceeded the contractual expectation that 90% of payment claims be paid within 14 days.  Old Medicaid never had an expectation for payment claims.  This is consistent with the old Medicaid program paying an average of 7-10 days.


  • Mental Health Care Coordination:  Modernizing our mental health system and ensuring coordinated care is a cornerstone of Medicaid Modernization.  More than 29,000 adults and children with high-risk behavioral health conditions, now have a health care coordinator assigned to them integrating their medical, physical, and behavioral health needs.


  • Patients Receive Timely Helpline Services:  When patients have questions they can contact the health plans’ member helpline.  All three health plans exceeded the timeliness requirements required by their contract.  Also, the state conducts “secret shopper calls” to ensure quality of those helpline services.


  • Home and Community Based Services (HCBS) Waitlist Drops:  DHS tracks the HCBS waitlist for patients who receive services in the community instead of an institutional setting.  Since April 1, 2016, the HCBS waitlist has seen a reduction of 3,131. In addition, for the second quarter in a row, ever waiver category waitlist has dropped.  This means more patients are getting HCBS services and in a more timely manner.


  • Value-Added Services:  Over 67,000 value-added services in the past two quarters were utilized.  The health plans offer numerous value-added services that go above and beyond what traditional Medicaid benefits offer. These value-added services are intended for the right patient to improve their health and well-being including health incentives, tobacco cessation, and wellness programs. 


  • 100% of Grievances Resolved Timely: All the health plans resolved 100% of grievances timely. The old Medicaid program never had a requirement that grievances be resolved within appeals within 30 days. This expectation met by the health plans ensures patients get timely resolution.


  • Timely Pharmacy Prior Authorizations:  For the second quarter in a row, 100% of regular prior authorizations for pharmacy were completed within 24 hours of request. This ensures timely patient access to pharmaceutical treatment to manage medical conditions.